The question of why people really seek abortions, and the course of their lives afterward, has driven my career as a demographer. In 2007 I began what turned out to be a landmark, 10-year study that evaluated the real-life consequences of abortion on women’s lives. I was inspired to start this study, not because I wanted to engage in our nation’s decades-long bitter and politically charged abortion debate, but because I wanted to look more closely into the real-life experience of unwanted pregnancy: What happens when someone is pregnant but feels they don’t have the money, physical strength and wellbeing, or emotional and social resources to raise a child? And how does the trajectory of their lives change when they are able to get an abortion — or when they can’t?

My study, which came to be known as the Turnaway Study, followed a thousand women who sought abortions from one of 30 abortion facilities across the country. Some of these women received an abortion and others, who were too far along in pregnancy, were turned away. By following those women for years afterward, we were able to compare the outcomes for those getting an abortion versus those who carried an unwanted pregnancy to term. My team of researchers conducted 7,800 interviews over the 10 years of the study.

What we found is that decisions about abortion and pregnancy are often driven by the desire to be a good parent. Among people seeking abortion, 60 percent already had children and 40 percent said they want to have a child in the future. Far from being irresponsible, the women we interviewed knew full well what is involved in having children and wanted to wait to do so under the right circumstances. Most commonly, those seeking abortion said they were not financially prepared to take care of a child. Others said it wasn’t the right time for a baby or that they wanted to focus on the children they already had. In other words, many people, like my grandmother, choose to wait to have children until they are better able to support a family.

Six Predictions

Little did I know in 2007, when I was just starting to pilot test our surveys, how relevant the study would become. Soon, the Supreme Court will likely allow abortion to become illegal in half of the states of our country in its decision in Dobbs v. Jackson Women’s Health Organization. What this means is that in large parts of the country, many pregnant people who want an abortion are about to be “turned away” as were the women we interviewed for the study.

Here are six predictions of the likely consequences, based on my research.

1. Wealthier Americans will still get abortions. Lower-income Americans will have children at the wrong time. There is a slogan, based on the experiences of pre-Roe America that says, “You can’t ban abortion, you can only ban safe abortion.” But the Turnaway Study suggests a more nuanced outcome than a proliferation of back-alley abortions. In states that ban abortion, people with the information, financial resources and physical capability will travel hundreds of miles to get an abortion in another state or find a way to access medication abortion pills online. These abortions will be as safe as if they had occurred in their own state, as long as it doesn’t take people too long to get them. But people without the means to circumvent their state’s laws will give birth instead. My conservative estimate, based on studies of other restrictions on abortion, is that a quarter of those who would previously have been able to get an abortion will instead give birth. Already in the United States, thousands of people who want abortions can’t get them. Abortion bans will sharply increase this number.

2. People who are pregnant and don’t want to be will face serious physical health risks. Abortion foes often talk about the health risks of ending a pregnancy, but in fact, our research found that abortion poses many fewer physical risks than full-term pregnancy. Some people forced to carry a pregnancy to term will die. This is not hypothetical: Two young women in our study who had sought and been denied abortions died as a result of their pregnancies. This tragic outcome will be more common when we are talking about as many as a hundred thousand people unable to get an abortion and carrying unwanted pregnancies to term. In the U.S., we are already facing a crisis of maternal mortality whereby American women, particularly Black women, die at rates far higher than those of other developed countries. For those who don’t experience serious medical complications, pregnancy still has significant lasting effects on health. The pregnant body literally depletes and reshapes itself to create a new being — taking calcium from bones, increasing blood volume, lowering immune defenses to tolerate the new occupant, and rearranging internal organs, muscles, ligaments, and bones. The consequences for physical health persist for the rest of one’s life. We saw this in the study; women who carried their pregnancies to term reported a higher incidence of hypertension and chronic pain and a greater likelihood of poor health compared to those who received an abortion.

3. Few people will place their children for adoption. During oral arguments in December of last year, Amy Coney Barrett suggested that women could simply drop off their newborns at hospitals or fire stations to be adopted by other families. The Turnaway Study results indicate there will likely be no great increase in the “domestic supply of infants” for adoption. We found that when someone has gone through the literally life-threatening process of staying pregnant and giving birth, the vast majority — about 90 percent — choose to parent the child.

4. More unwanted births now will result in fewer wanted births later. Based on Turnaway Study findings, I do not anticipate that banning abortion will result in a large increase in the total number of children born. Yes, in states that ban abortion, approximately a quarter of women who otherwise would get an abortion will give birth. But these births will come at the cost of people having wanted pregnancies later. Banning abortion means that people have children before they’re ready — and then are less likely to have children later, either because they have had all the children they can care for or because, although they may want more children, their life circumstances don’t improve to a point where they can do so.

5. Those unable to get an abortion will experience economic hardship and curtailed life ambitions. It is not news that having children is expensive. But the experience of people who can’t travel because of cost or illness is going to be about more than just the difficulty of being a parent on limited incomes. The Turnaway Study shows that when women can’t get abortions, they are less financially stable. They are less likely to be able to work a full-time job. They are more likely to receive public assistance but not enough to keep their families above the poverty level. Years later, those denied abortions are still more likely than those who receive them to not have enough money for basic living needs; they have higher debt and are more likely to have been evicted. One of the most poignant findings of the study is that both life satisfaction and self-esteem drop when someone is denied an abortion. Having control over childbearing affects one’s assessment and enjoyment of life. Women who have abortions more often go on to accomplish other life goals such as finding a full-time job, finding more satisfying romantic relationships, and achieving other aspirational plans.

6. More children will be raised in poverty and strain. The Turnaway Study found that children born because their mother was denied an abortion were more likely to live in poverty and their mothers report worse emotional bonding with the child than children born later to women who managed to get an abortion. The data also show that women’s existing children suffer when women lose control over the circumstances and timing of subsequent births. These older children are more likely to live in poverty and less likely to achieve developmental milestones.

My Other Grandmother

My research was empirical, but these conclusions played out in a real way in my own family. If my paternal grandmother’s story shows how access to abortion can improve a family’s life, the story of my grandmother on my mother’s side shows some of the downsides of carrying an unwanted pregnancy to term.

Dorothy became pregnant when she was 19. She had been raised in a very strict Christian home, and her parents were furious about her pregnancy. They pressured her to have an abortion, seeing it as a solution that would enable her to put this shameful incident behind her and get her back on track to find a husband and then have children. Yet she resisted, perhaps because she was fearful of having an illegal procedure, so they sent her to the Salvation Army Home for Unwed Mothers.

When my mother was born, Dorothy placed her for adoption, as was expected for white unmarried women in the decades before Roe. But she never got back on the track her parents had wanted for her. Childbirth caused a long period of disability and, since her parents had turned her out, she had to recuperate at the home of a friend she met at the home for unwed mothers. This friend’s brother raped her while she was still recovering from having given birth. Dorothy told me that what hurt most was why he did it. He told her, “she was already no good,” as if an out-of-wedlock pregnancy meant she could be used and abused because, once her reputation was damaged, she had lost all right to bodily autonomy.

Dorothy went on to have an interesting life, but it did not include marriage and children. And when my mother found her—when my mom was 44 and I was 12—she was happy to be found. One of the first things she said to my mother was, “Aren’t you glad I didn’t have an abortion?” And although my mother was glad to be alive, Dorothy had clearly more complex feelings about her whole experience – the pregnancy, the treachery of the man involved, the rejection by her parents, the complications of delivery, surrendering of her child, the rape, and most of all, a deteriorated sense of self-worth. She was an avid scrapbooker but the slim volume of pictures of my mother and our family was kept separate and secret, still clouded in shame after so many years.

I was close to my grandmother; she was my nearest relative when I moved across the country to go to college. She was very proud of my graduate degrees and my research. But I strongly suspect that she was even more proud of the fact that I had married and had children – a level of social acceptance that was not accessible to her.

The stories of my grandmothers come from a pre-Roe era, before a constitutional right to abortion had been established. In the intervening years, women’s rights and abilities to take part in American society have improved in many ways. Contraception and abortion have played a large part in that history. But because these are decisions people make privately, it may not be apparent to many people how significant abortion has been to the wellbeing of American families.

It is a fundamental principle of American society that we respect a person’s freedom to make decisions about their private lives. And there is no decision more personal than whether and when to have a child. Now we are confronted with the prospect of a post-Dobbs world in which millions of Americans will lose the ability to determine the outcome of unwanted or dangerous pregnancies.

The Turnaway Study provides insight into what we can now expect on a larger scale. Over the long term, I anticipate only a modest increase in babies born and placements for adoption. Instead, by forcing some pregnant people to have a child under adverse circumstances – inadequate financial or emotional support, low-quality relationships, poor health – our country will make parenthood more difficult, increase financial strains on young families and adversely affect the long-term wellbeing of families and children.